Prospectus Hit and Run

Labrum But it Didn't Kill Him

On Wednesday, the Yankees revealed that Michael Pineda had suffered a torn labrum, a devastating turn of events both for the 23-year-old righty and for the team that acquired him from the Mariners for top prospect Jesus Montero back in January. Pineda will miss the entire season and part of 2013, thinning the Yankees' surplus of starting pitching—and underscoring the fact that you can never have too much—while raising the question of whether they will ever get much value out of him.

Far from charging that they had received damaged goods from the Mariners, the Yankees believe that Pineda suffered the tear at the end of a rehab outing last weekend, when he left after 15 pitches, complaining of lingering pain in the back of his shoulder. Pineda struggled to ramp up his velocity throughout the spring, a problem the team blamed on his lax conditioning over the winter, and one all too reminiscent of Phil Hughes' saga last spring. As general manager Brian Cashman noted, the team did a full physical on Pineda, including an MRI of his shoulder, at the time of the trade, and did another on March 31 that revealed nothing more than tendonitis. The tear was discovered only via a dye-contrast MRI, which is used to improve the visibility of such images. On Wednesday, Cashman conceded, "I think it's real fair to speculate that there was something there, laying dormant, that wasn't detectable during regular MRIs.”

While success rates for Tommy John surgery run in the 85-90 percent range among professional pitchers in terms of returning to full strength, they're still much lower for labrum surgeries. In fact, once upon a time, a torn labrum was close to a death sentence for a pitcher. Back in 2004, BP's injury expert, Will Carroll, penned a chilling article for Slate, "Labrum, It Nearly Killed Him," detailing the lack of success doctors have had in treating such injuries. Of the 36 pitchers Carroll studied who had undergone labrum surgery, just one—middle reliever Rocky Biddle—had returned to his previous level. "The leading minds in baseball medicine are flummoxed by the labrum," wrote Carroll. "Doctors can't agree on how to detect a tear, don't know the best way to fix one, and aren't sure why, almost without fail, a torn labrum will destroy a pitcher's career… [I]f pitchers with torn labrums were horses, they'd be destroyed."

In the eight years since then, sports medicine has made considerable advances, and we now have a share of successful post-labrum surgery stories among pitchers. However, that doesn't mean that their injuries were comparable to Pineda's, so coming up with appropriate comparisons is difficult.

With the help of current BP injury guru Corey Dawkins and his database, which goes back to 2002, I compiled a list of major-league pitchers who underwent some sort of labrum repair surgery, with aftermaths ranging from Hall of Fame-caliber successes (Roger Clemens, Curt Schilling) to premature retirements (Mark Mulder), or complete failures to return to the majors (Mark Prior). This list, which I supplemented by combing through Google in search of other names that arose in the wake of the Pineda news, isn't comprehensive, and I've made no attempt to double back to ensure the inclusion of the 36 pitchers Carroll studied, though some arise here. The list, which includes 67 pitchers (the Google doc is here), is useful as a general survey of the labrum landscape and as a starting point for finding comps for Pineda.

Before I delve into that search, a bit of anatomical review is in order for those who so desire. The labrum is a ring of fibrous cartilage that surrounds the end of the scapula (the shoulder blade) and holds the head of the humerus (the upper arm bone) in the glenoid fossa as a ball-and-socket joint. The most common injury we tend to hear about with regards to the labrum is the SLAP tear, which stands for Superior Labrum Anterior to Posterior, a front-to-back tear of the upper labrum. Dawkins wrote at length about SLAP tears over the winter, noting that they rarely happen in isolation and are often associated with rotator cuff tears, shoulder impingement, and AC joint issues. I myself am a SLAP tear survivor, having undergone surgery in November 2003 following an accident five months earlier; doctors are still searching for my fastball.

Of the 67 pitchers I identified, 20 didn't return to the majors at all, though that count includes two (Jon Garland and Peter Moylan) who underwent surgery too recently to be counted out. Six of the remaining 18 (Matt Clement, Dirk Hayhurst, Eric Hurley, Prior, Brandon Webb, and Paul Wilson) pitched in the minors but were unable to pitch well enough to return to the majors; Hayhurst, Hurley, Prior, and Webb were active last year, and may yet write happier endings to their tales of woe. Nineteen others pitched less than 50 major-league innings following surgery, a count that includes the still-active Jose Ascanio, Travis Blackley, Boof Bonser, Brandon Lyon, Dustin McGowan, Troy Patton, and Clayton Richard; those 19 have totaled exactly 0.0 WARP in their post-surgical careers. So that's 58 percent with little to no return thus far. Fifty-seven percent of our "notable" list, mind you; doubtless there are dozens (hundreds?) of minor leaguers who aren't included here.

On the other hand, five pitchers (Clemens, Schilling, Al Leiter, Chris Carpenter, and Gil Meche) threw more than 1,000 innings following the surgery, and another six (Scott Elarton, Jason Isringhausen, Ted Lilly, Jon Rauch, Anibal Sanchez, and Jose Valverde) have topped 400 innings. All of the latter group are active, with all but Elarton posting sub-4.00 ERAs to boot, suggesting at least some amount of success. That's about 16 percent of our notables who can be counted as some significant level of success. The average for that group is 21.8 WARP post surgery, but that's drastically skewed by Clemens and Schilling; among the other nine, it's 10.0 WARP. That leaves another 17 pitchers (25 percent) floating somewhere in between those two poles, with seven of those 17 still active; the average post-surgical WARP for this group is just 1.8.

The far right column of the Google document is where I've included notes from our database on additional damage a pitcher may have had repaired, either at the time of the labrum surgery or shortly thereafter—a critical detail when it comes to gauging the success of these surgeries. Twelve of those pitchers had some kind of surgery to repair frayed or degenerated labrums, which classify as more of a wear-and-tear issue than what Pineda is dealing with, so they're not appropriate comps. Likewise, 25 of these pitchers (including some of those frayed-y-cats) had labrum injuries accompanied by rotator cuff tears of some severity; indeed, several of them are in our database only as rotator cuff injuries, though Googling the appropriate articles confirms that they suffered labrum injuries as well.

As Yankees team physician Dr. Chris Ahmad noted, Pineda's rotator cuff is undamaged, a key detail when it comes to his outlook: "When the rotator cuff is damaged as part of the injury problem, that has a much worse prognosis and influences velocity and ability to pitch. His rotator cuff looks great, and this is isolated to his labrum, and that’s why we feel more optimistic about him having a good result."

Those pitchers with bursa, shoulder capsule, or biceps tendon issues can be eliminated as Pineda comps, as can others once we explore the specifics of their injuries. Clemens, who underwent labrum surgery after just his second year in the majors, was injured in a different part of his labrum, so he's not an appropriate comp—which is too bad, because he rebounded to win the AL Cy Young and MVP awards the following year while leading the Red Sox to a pennant. Schilling's injury was a SLAP tear, as were those of Carpenter, Kelvim Escobar, and several others already eliminated from the discussion via one of the aforementioned routes. Pineda's tear is apparently not a SLAP tear.

In the end, Dawkins offered three pitchers as reasonable comps based upon the fact that they weren't SLAP tears and hadn't suffered any rotator cuff damage:

As Meat Loaf sang, two out of three ain't bad, at least in terms of careers that resumed. Sanchez had 23 major-league starts, 144 1/3 innings, and a no-hitter under his belt when he underwent labrum surgery in June 2007, when he was 23, the same age as Pineda. He returned to the majors 13 months later but struggled, pitching to a 5.57 ERA in 51 2/3 innings in 2008. He was more effective in 2009 (3.87 ERA in 86 innings) but lost about half of the season to a shoulder strain. Just when it seemed he might never survive a full season, he reeled off two very strong ones (195 innings, 3.55 ERA, 3.4 WARP in 2010; 196 1/3 innings, 3.67 ERA, 2.7 WARP in 2011), and he's off to a solid start in 2012.

Valverde had two seasons totaling 80 big-league innings for the Diamondbacks before he underwent surgery in September 2004. He was back in the majors by May of the following season, so his injury must not have been as severe. Since then, he's been a very successful closer, averaging 32 saves per year and leading the league three times.

Miller, the oldest of the trio, had amassed 859 big-league innings prior to surgery, with a particularly strong run from 2001-2003 for the Astros in which he averaged 188 innings and 2.6 WARP, with a 3.61 ERA. Prior to surgery in late 2005, he had already lost a total of 217 days to the disabled list over the 2004-2005 seasons due to shoulder inflammation and rotator cuff fraying. He spent two years trying to recover his form for the Cubs but never came close; as late as 2009, he was still on the comeback trail with the Blue Jays. He's a grim comp, but due to the mileage that was already on his shoulder, perhaps he’s a less fitting one than the other two pitchers.

All of which is sobering data when it comes to assessing Pineda's outlook. The wisdom of the Yankees trading their best hitting prospect for a pitcher will be debated for years to come in the Bronx and elsewhere, and somewhere, somebody with column inches to fill will trumpet the notion that the Mariners are winning the trade, this despite the fact that both Montero (.281/.294/.391, 0.0 WARP) and Hector Noesi (-0.2 WARP) have been replacement level or worse in the small sample of the 2012 season. As I pointed out when Fox Sports trumpeter Jon Paul Morosi gleefully proclaimed the score, the Mariners may actually be losing the deal given that they're squandering the service time of the trade's key asset in a season in which they're unlikely to contend. Keeping Montero down through April would have bought the Mariners another year before free agency, while keeping him down through June or July would have prevented him from becoming a Super Two.

The Yankees have five years of club control over Pineda and six over Jose Campos, a 19-year-old who's tearing up A-ball, so we're a long way from seeing how this trade pans out. The history of pitchers recovering from labrum injuries suggests the Yankees are at a disadvantage, but they're not licked yet, and so long as Montero struggles to carve out a spot as a catcher—as opposed to a designated hitter—this isn't going to be a runaway.

​Thanks to Corey Dawkins for his assistance with this column.

Jay Jaffe is an author of Baseball Prospectus. Click here to see Jay's other articles.
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Why don't teams perform routine monthly MRIs on all quality pitchers in the org.? It takes 30 min., is non-invasive and costs all of $500. Why wait until the pitcher complains of pain or shows decreased performance?

It's an interesting question but MRIs cost more than $500, probably closer to $2,000 a pop (http://www.comparemricost.com/). A team that owns its own equipment - an investment upwards of $1 million in terms of hardware - could eventually realize some savings there, but it's not a trivial expense.

I had SLAP repair done in 2002 while I was in the Marine Corps. Let's just say the Dept of the Navy doesn't use its best surgeons for enlisted guys. I have had nothing but pain and problems since and extensive nerve damage. My shoulder is messed up enough that I received a disability rating for it. I was a decent American Legion pitcher (could hit 75-80 on the gun) now I can't hit the relay guy from the OF in beer league softball. Hope Pineda recovers.